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estradiol gel (Divigel)
How does this medication work? What will it do for me?
Estradiol gel belongs to the class of medications known as estrogen replacement therapy. It is used to manage menopausal symptoms such as hot flushes, irritation of the vagina, and sleep disturbances. When estradiol gel is applied to your skin, it releases estradiol into your blood through your skin.
Estradiol is a type of estrogen, a female hormone that is produced by the ovaries. At menopause, the amount of estrogen made by the ovaries declines and symptoms such as hot flushes (sudden, extreme feeling of warmth) and vaginal dryness can occur. Most women reach menopause naturally around the age of 50, but some women may undergo menopause sooner, due to many causes, including surgery.
Women who have not had a hysterectomy (removal of their uterus or womb) must also take another female hormone called progestin while they are taking this medication to prevent complications associated with taking estrogen alone.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
The clear, colourless, smooth, opalescent gel contains estradiol 0.1% supplied in single dose foil packets containing 0.25 mg, 0.5 mg or 1.0 mg of estradiol. Nonmedicinal ingredients: carbomer, ethanol, propylene glycol, purified water, and triethanolamine.
How should I use this medication?
The gel is usually applied once daily. The recommended starting dose is 0.25 mg daily. Your doctor may adjust your dose based on your response.
To apply the estradiol gel, open the foil packet and squeeze the entire contents onto the skin of the upper thigh. Spread the gel in a thin layer over an area of about 5 to 7 inches or the size of two palm prints. Allow the gel to dry completely before dressing. To avoid skin irritation, rotate between the right and the left thigh each day.
Do not apply the gel to the breasts, face, vagina or to irritated or damaged skin.
Discard the empty foil packet into a garbage container that cannot be accessed by pets or others in the household. Wash your hands when you are finished. Do not let others come in contact with the area of skin where you applied the gel for at least one hour after you apply the gel.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.
It is important that this medication be used exactly as prescribed by your doctor. Apply the gel at the same time each day. If you miss a dose, do not double the dose the next day. If your next dose is less than 12 hours away, wait and apply your next dose the next day, as usual. If it is more than 12 hours until the next dose, apply the dose you missed, and resume your normal dosage the next day. If you accidentally spill some of the contents of a packet, do not open a new packet. Apply your normal dose the next day.
This medication is flammable because the gel contains alcohol. Avoid fire, flame, or smoking until the gel has dried. Allow the gel to dry for approximately 2 minutes before covering it with clothing.
Store this medication at room temperature, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not use estradiol gel if you:
- are allergic to estradiol gel or any ingredients of the medication
- are or may be pregnant or breast-feeding
- experience migraines that are accompanied by a visual aura or disturbance
- have active phlebitis (inflamed varicose veins)
- have heart disease or have had a stroke
- have had breast or endometrial cancer, except in special circumstances
- have liver dysfunction or disease, especially of the obstructive type
- have or have had blood clots in the legs (deep vein thrombosis), lungs (pulmonary embolism), or heart (heart attack)
- have partial or complete loss of vision, or double vision from eye disease related to circulation problems
- have unusual vaginal bleeding and have not consulted a doctor about it
- have excessive growth of tissue in the uterus
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is used in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who uses this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- breast pain or tenderness
- fluid retention
- migraine headaches
- skin irritation
- stomach cramps and bloating
- weight gain
Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- abdominal tenderness, or persistent upper abdominal pain
- breast lumps
- changes in menstrual periods
- increased blood pressure
- problems wearing contact lenses
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
- unexpected vaginal bleeding
Stop taking the medication and seek immediate medical attention if any of the following occur:
- headache (sudden or severe)
- irregular or fast, pounding heartbeat
- signs of a blood clot in the arm or leg (tenderness, pain, swelling, warmth, or redness in the arm or leg) or lungs (difficulty breathing, sharp chest pain that is worst when breathing in, coughing, coughing up blood, sweating, or passing out)
- signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
- signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
- sudden vision changes (such as partial or complete loss of vision, double vision)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Important information about estrogen:
- This medication should be used at the lowest dose that relieves your menopausal symptoms for the shortest time period possible.
- Estrogens should not be used to prevent heart disease, heart attacks, or strokes.
Blood clotting disorders: Estrogens should not be used by people with active thrombophlebitis (inflammation of a vein leading to a clot) or thromboembolic disorders (diseases of blood clotting and abnormal circulation). Some studies have suggested that there is an increased risk for healthy women to develop blood clots in the groin, legs, or lungs (conditions called deep vein thrombosis or pulmonary embolism) when taking hormone replacement therapy.
Women with severe varicose veins or severe obesity (body mass index (BMI) more than 30 kg/m²), and those needing to stay in bed for 3 weeks or more, are generally considered to be at increased risk of blood clots.
If you have a family history of thromboembolic disorders (see above), or have experienced a blood clot either during pregnancy or while taking estrogens, inform your doctor so that you can be monitored closely. Women with cerebrovascular disease (such as stroke) or coronary artery disease (such as angina) should use estrogens with caution, and only if clearly needed.
Blood pressure: Increased blood pressure is not uncommon for women using this medication. Blood pressure should be monitored with estrogen use, especially if high doses are used.
Bone disease: Estrogen can change the way your body uses calcium and phosphorus. If you have bone disease due to cancer or a metabolic condition causing too much calcium in your body, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Breast cancer: Studies indicate an increased risk of breast cancer with long-term use of estrogen replacement therapy. Women who have breast nodules, fibrocystic disease, abnormal mammograms, or a strong family history of breast cancer should approach the use of estrogens with caution. Women taking estrogens should have regular breast examinations and should be instructed in breast self-examination. This medication must not be applied to the breasts, as it may have harmful effects on the breast tissue.
Diabetes: Estradiol may cause a change in blood sugar levels and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.
If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Dementia: Recent studies have indicated that the use of estrogen, with or without a progestin may contribute to the development of dementia for women over the age of 65. If this is a concern, contact your doctor.
Endometrial cancer: There is evidence from several studies that estrogen replacement therapy, including estradiol, can increase the risk of cancer of the endometrium (lining of the uterus). Taking a progestin at the right time along with the estrogen reduces the risk of endometrial cancer to the same level as that of a woman who does not take estrogen. For this reason, all women who have not had their uterus removed should also take a progestin if they are using estrogens.
Endometriosis and fibroids: This medication may worsen fibroids, causing sudden enlargement, pain, or tenderness. It may also cause worsening symptoms of endometriosis. If you have had endometriosis or fibroids in the past, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you notice any abdominal tenderness or pain, contact your doctor as soon as possible.
Fluid retention: Estrogen may cause fluid retention, which may cause worsening symptoms of heart or kidney dysfunction, or asthma. If you have any of these conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Gall bladder disease: Estrogens may increase the risk of gall bladder disease. If you have a history of gall bladder disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Heart disease: There is evidence from recent studies that the use of estrogen plus progestin may cause an increase in the risk of heart disease. If you have heart disease or are at risk of heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
High cholesterol or triglycerides: Estrogen may increase triglyceride levels in those who already have high levels. This has been observed particularly when estrogen is taken orally (by mouth); the risk is reduced with use of the gel. Ask your doctor to monitor your cholesterol levels.
Kidney function: Estrogen can affect how calcium and phosphorus are metabolized by your body, which may be a concern if you have kidney disease. If you have decreased kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver function: Estrogens may cause liver problems or make existing liver problems worse. If you have a history of reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.
Migraine headaches: Estrogen can cause an increase in migraine headaches or cause migraine headaches to develop. If you have a history of migraine headaches, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you develop worsening symptoms of migraine headaches or develop headaches with an aura (flashes of light, halos) contact your doctor as soon as possible.
Ovarian cancer: There is evidence from several studies that the use of estrogen replacement therapy for a long period of time (particularly 5 or more years) may increase the risk of cancer of the ovaries.
Seizures: Estrogen can increase the frequency of seizures for people with epilepsy. If you have a seizure disorder such as epilepsy, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Thyroid disease: Estrogen affects how your body uses thyroid hormone. If you take thyroid replacement therapy, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: Estrogen should not be used during pregnancy as it may be harmful to the developing baby. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: Taking estrogen while breast-feeding may decrease the amount and quality of breast milk. Estrogen is also passed through breast milk to your breast-feeding child. Breast-feeding is not advised while taking this medication.
Children: The safety and effectiveness of this medication have not been established for use by children.
What other drugs could interact with this medication?
There may be an interaction between estradiol gel and any of the following:
- "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
- calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
- corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
- desiccated thyroid
- diabetes medications (e.g., chlorpropamide, glyburide, insulin, metformin, rosiglitazone)
- grapefruit juice
- hepatitis C antivirals (dasabuvir, ombitasvir, paritaprevir)
- HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
- macrolide antibiotics (e.g., clarithromycin, erythromycin)
- St. John’s wort
- saw palmetto
- vitamin C
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Divigel